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There’s a world of global patent debates raging beyond all this domestic intellectual property chicanery. Both the World Trade Organization and the United Nations have been addressed by many activists arguing that epidemics in poor countries justify the emergency production of mass quantities of cheap generics. An Indian company, Cipla, was ready to prepare a retroviral cocktail for Doctors Without Borders to distribute in Uganda and Ghana, when GlaxoSmithKline got all shirty and legal, accusing the Indians of piracy. By the end of 2001, however, all the bad publicity and angry people in the streets shamed Big Pharma into allowing the manufacture of generics in Africa and selling their products at reduced prices. Activists insist that the drugs remain far too pricey for most people with AIDS in poor countries, and that more assistance is required.

But let’s go back to the patent—and hanging on to it at all costs. If all the legal and semilegal stalling doesn’t work, makers unveil an ostensibly improved version of the old drug. Claritin is trumped by Clarinex. Prilosec, the original purple pill, gives way to today’s purple pill, Nexium. The other way to hang on to your patent is to find a new use for the old drug. Lilly tried to stave off the horrors of patent expiration by rebranding its greatest hit, Prozac, as Sarafem, a cure for premenstrual dysmorphic disorder. PMDD is basically PMS Turbo. PMS has always mystified me, not because it doesn’t exist, but because it does, and almost every woman I have met in my life has some twinge or symptom of it. And the stats back up my anecdotal tales of gal pals having backaches or bursting into tears; about two-thirds of women are affected. This makes me wonder how anything that afflicts that much of a given population can possibly be considered a disease. Aren’t the minority of the sisterhood who flounce through the month unhindered the anomalous ones? If almost everybody feels something to the point where it is the stuff of coffee-mug and T-shirt slogans, then surely it is not a disorder, but normal—a thing simply to be endured, and tamed with the usual low-grade anodynes.

Lilly insisted that PMDD, Xtreme PMS, was downright debilitating, and sold Sarafem with the classic pitch-to-the-ladies, the empowerment message, encouraging women to liberate themselves from the tyranny of bloat and moods. The ads for the little lavender and pink pills encourage gals to “be more like the woman you are.” Lilly got its knuckles rapped by the FDA for one ad in particular. It showed a young woman struggling unsuccessfully, and with increasing hysteria, with a fiendishly uncooperative grocery cart. The FDA argued that the ad trivialized the disorder, which strikes me as pretty funny, considering that the whole point of Lilly’s campaign was to give PMDD the gravitas of a disease so that they could supply the cure.

Paxil, never far behind Prozac, took a similar tack with a campaign about social anxiety disorder, and then generalized anxiety disorder, providing shiny new diseases for a drug known primarily as an antidepressant. In case you aren’t up on your disorders, those are Turbo Shyness and Xtreme Jitters, respectively. Many pharmaceutical marketing campaigns don’t sell the cure. They sell the disease, identifying a cluster of symptoms and giving them a name. And once a company finds a best-selling malaise, they start marketing all the adjacent feelings. Depression begets a host of anxiety and panic disorders. Viagra and Cialis prove an astounding success, and so we are treated, or soon will be, to campaigns about the scourge that is female sexual dysfunction.

This is not to discount the genuine therapeutic benefits of prescription drugs, which have helped people recover from debilitating conditions. Depression is bloody awful, and if Prozac can shake you out of it, more power to you and Lilly and your caring clinicians. But it’s not as easy to diagnose a depression as it is to spot a tumor or a blood pressure problem. There’s no way to really test people for many of the disorders for which antidepressants are prescribed, other than some shrinky-dinky quizzes, which seem to get more and more general with each passing drug. CNN recently did a spot on a new drug for attention deficit disorder called Strattera. The anchors joked about the website’s diagnostic questions: Do you feel unfocused, disorganized, or restless? Yes! Are you unable to concentrate on any one thing for any length of time? So true! Meanwhile, the crawl beneath the picture carried the latest blips about Bush and Laci Peterson, while the current temperatures and sports scores flashed in another corner and, in the background, more monitors blinked. Who could focus on anything for any length of time? The Lilly website even compares the condition to a “channel [that] keeps changing in your mind and you don’t have control of the remote.”

The snappier turnaround times demanded by an overburdened health care system mean that way too many doctor appointments are little more than ill-defined complaints and pitches for a quick fix. You tell ’em you feel like six pounds of shit in a five-pound bag and that you’ve heard of this new miracle cure, and then they hand you a couple of sample packs, a pamphlet, and a scrip. The laundry list of disorders for which antidepressants are prescribed has increased and now includes everything from body dysmorphic disorder to posttraumatic stress disorder to gambling, shopping, and sex addictions. And every one of these relatively new disorders has enjoyed at least fifteen minutes of fame, often in the form of designated celebrity sufferers, magazine spreads, or a very special day on
The Oprah Winfrey Show
or
Dr. Phil.

Feeling like six pounds of shit in a five-pound bag is nothing new. There have been melancholias and manias on the medical books since the Ancient Greeks. In a more churchy time, these symptoms might have been interpreted as demonic possession and treated with exorcism, or maybe a trepanning, or perhaps a good bleeding to get your humors back in working order. In the early days of psychoanalysis, the same symptoms might have been evidence of a neurosis or a block, and the patient would have had to talk his or her way through it, in search of primordial trauma, perhaps under the influence of hypnosis or cocaine. Over the course of the last century, doctors developed brutal surgical interventions like lobotomies to try to tame mental illness, but pharmaceuticals have been the preferred form of treatment since the seventies. The first few classes of antidepressants, the tricyclics and the MAOIs, had rotten side effects like dry mouth, blurry vision, sweating, and severe, sometimes fatal, allergic reactions that discouraged their widespread use.

It was not until the early nineties that things began to change. In the post-Prozac world, a World Health Organization study on depression estimated that 121 million people suffered from the disorder, and that only a quarter of them had access to treatment. Now I hate to make chicken and egg arguments, but which came first, the miracle cures or the global depression epidemic? My money’s on the cures. Since the new, ostensibly side-effect-free SSRIs became available, the number of people who seek treatment for depression has tripled, and the use of antidepressants has more than doubled. Hell, I’ve taken one, too. Paxil was another one of those drugs that I did briefly, and didn’t much care to continue doing. I took it for a couple of months, until I wasn’t freaking out anymore, and then stopped because it made me feel fizzy, numb, and wired. I know plenty of people, more cranky than crazy, who have also given one of the SSRIs a whirl, and I suspect you know a few, too.

According to a report by the American Medical Association, part of the reason for this is the increased public profile of such drugs, as well as the general destigmatization of mental illness. Once upon a time you might have kept your mad relatives in the attic, away from prying eyes; now we blab in locker rooms and chat rooms about our meds. The shift was suspiciously sudden. Granted, the freedom to discuss our own bouts of insanity seems an improvement over locking ourselves or our loved ones up, but it also testifies to the awesome power of marketing.

Are millions of us really that fucked-up? And if, indeed, the fucked-up are legion, then shouldn’t we be sniffing around for the reasons behind the depression epidemic? Either way you look at it, it’s pretty depressing. Millions of people may well be taking drugs they don’t need to clear up a medical condition that is nothing more than a glorified bad mood. On the other hand, millions of men, women, and children might be seriously ill for reasons we don’t understand, and might find themselves dependent on drugs, with all the side effects, long-term effects, and costs that situation implies. Take your pick: a massive snake-oil swindle or a ginormous public health crisis.

SSRIs clearly have their uses. For those afflicted with severe depression, the four food groups and a daily stroll will not suffice. However, I suspect that too many people label themselves depressed and turn to pills too quickly, since they provide the promise of a much easier fix than the kind of lifestyle changes that actually lead to better physical and mental health. If your day consists of sitting in a car snorting fumes, sitting in front of a computer screen, sitting in a car again, and then sitting in front of a television screen while grazing on all manner of toxins and worrying intermittently about your debts, your job, and your relationships, then it is little wonder you do not feel very good. You should not feel good. That pain is your body saying quit it with the shitty life. Doing the good-health thing requires rearranging your schedule, which you might not have the leeway and resources to do, and waiting a while for the effects to kick in. With a pill, you just buy it and swallow it. We’re good at buying and swallowing.

If you look at the top killers in the U.S.—heart disease, stroke, cancer, chronic lower respiratory disease, pneumonia/ influenza, liver disease—you will see that there is not one blockbuster pill that cures any of them. There are some peripherals, sure, to keep your cholesterol down and maybe help with the heart. But most of these diseases spring from a lifetime of bad habits. These are the diseases of a stressed-out people who do not get enough exercise, eat too much lousy food, and marinate in a soup of chemicals. So when the works inevitably begin to rot, why not throw more chemicals into the mix? Fire with fire, baby. Here’s another list: the top ten global pharmaceuticals in 2003 were Lipitor, Zocor, Zyprexa, Norvasc, Procrit, Prevacid, Nexium, Plavix, Advair, and Zoloft, for cholesterol, cholesterol, depression, hypertension, anemia, heartburn, heartburn, blood clots, asthma, and depression, respectively. The list of mortality leaders and wonder drugs doesn’t match up as nicely as one might hope it would. Throw in estrogen therapy, antibiotics, painkillers, Accutane, and Viagra, and that about sums it up for the fifty best-selling drugs, which account for half of all drug sales.

We take pills to chase away the erosions and abrasions of our bad habits, not to cure any of the illnesses that actually dispatch us to the worm farm. It’s like Chris Rock said: “There ain’t no money in the cure.” All drug dealers, from the CEOs of Big Pharma to the kingpins of the illegal trade, are looking not for the cure, but for the chronic, the product the junkie needs a little bit of every day for the rest of his or her life. There’s a pill for every age of man, and every complaint that accompanies that age. The fidgeting and flightiness of youth can be curbed with Ritalin, or Strattera, or some other copycat version of speed for kids. The miseries and confusion of adolescence and early adulthood can be managed with one of the SSRIs. If the spuds are looking runty, you can start them on a course of Humatrope, the growth hormone, so they can get in on the benefits of a few extra inches. The wear and tear of middle age can be assuaged with your Celebrexes, your Prilosecs and your Nexiums. And your golden years will involve, more likely than not, handfuls of pills, so many pills that some of them will be pills you take simply to counteract your other pills.

We may be caught up in healthism, but we are far from healthy. Half of us North Americans are obese. Even as the prescriptions and the AbTronics and ginkgo biloba fairly walk off the shelves, our obesity rates continue to rise, and obesity is right up there with smoking as a grievous mortality factor and preventable cause of disease.

A pill doesn’t change your habits. It’s just another habit, another product to add to your daily regime of consumption, another chemical introduced into the mix of chemicals. People used to take pills either as a matter of the utmost medical exigency, or to liven up a night on the dance floor. Now people take pills simply to be themselves. Paxil encourages you to see someone you haven’t seen in a while—namely, you. It’s natural to be chemical. And, as anyone who has done drugs knows, doing drugs is the leading cause of doing more drugs. You either develop a dependency and need more of the same old shit to feel it, or the first drug leads you to other drugs. Conservatives love to talk about the gateway effect when it comes to illegal drugs. Smoke a joint, and you’re on the road to junkiedom. But nobody breathes a word about the gateway effect of prescription drugs. I can’t help but wonder how many of those eager Prilosec consumers are taking it to soothe their burnt-out Prozac guts.

CHAPTER SEVEN